Shaping the Future of Behavioral Health: Understanding Drivers, Challenges and Opportunities

Pamela S. Hyde, J.D.SAMHSA Administrator

Mental Health AmericaAnnual Conference

Washington, D.C. • June 10, 2011

CONTEXT OF CHANGE – 1

Budget constraints, cuts and realignments – economic challenges like never before

No system in place to move to scale innovative practices and systems change efforts that promote recovery

Science has evolved; language and understanding is changing

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CONTEXT OF CHANGE – 2

Integrated care requires new thinking about recovery, wellness, role of peers, responding to whole health needs

New opportunities for behavioral health • Parity/Health Reform• Tribal Law and Order Act• National Action Alliance for Suicide Prevention

Evolving role of behavioral health in health care

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DRIVERS OF CHANGE 5

STAYING FOCUSED DURING CHANGE6

SAMHSA STRATEGIC INITIATIVES

AIM: Improving the Nation’s Behavioral Health1 Prevention2 Trauma and Justice3 Military Families4 Recovery Support

AIM: Transforming Health Care in America5 Health Reform6 Health Information Technology

AIM: Achieving Excellence in Operations7 Data, Outcomes & Quality8 Public Awareness & Support

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FOCUS AREAS FOR TODAY’S DISCUSSION

RECOVERY

DISPARITIES

BUDGET

BLOCK GRANT

NATIONAL BEHAVIORAL HEALTH

QUALITY FRAMEWORK

COMMUNICATIONS & MESSAGE

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RECOVERY: WORKING DEFINITION

Recovery from mental health problems and addictions is a process of change whereby

individuals work to improve their own health and wellness and to live a meaningful life in a

community of their choosing.

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RECOVERY: PRINCIPLES – 1

1. Person-centered

2. Occurs via many pathways

3. Holistic

4. Supported by peers

5. Supported through relationships

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RECOVERY: PRINCIPLES – 2

6. Culturally based and influenced

7. Supported by addressing trauma

8. Involves individual, family, and community strengths and responsibility

9. Based on respect

10.Emerges from hope

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RECOVERY CONSTRUCT12

SAMHSA STRATEGIC INITIATIVERECOVERY SUPPORT

Recovery domains

Recovery principles

Recovery month

Recovery outcome measures

Recovery TA Center (BRSS TACS)

Recovery curricula for/with practitioners

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DISPARITIES

Disparities• Ethnic minorities > HHS Strategic Action Plan to Reduce Racial & Ethnic Health

Disparities• LGBTQ populations > LGBT Coordinating Committee• AI/AN Issues > Tribal Consultations• Women and girls

Office of Behavioral Health Equity - Key Drivers & Activities• HHS Office of Minority Health five core goal areas: awareness, leadership,

health system and life experience, cultural and linguistic competency, and data, research and evaluation

• AHRQ’s National Healthcare Disparities Report – identifies improving, maintaining and worsening health indicators, including depression, illicit drug use and suicide

• SAMHSA’s Eight Strategic Initiatives• Workforce (NNED)

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National Network to Eliminate Disparities in Behavioral Health (NNED)

www.nned.net15

BUDGET: STATE BUDGET DECLINES

Maintenance of Effort (MOE) Waivers• FY10/SY09 – 13 SA waivers; $26,279,454• FY10/SY09 – 16 MH waivers; $849,740,799.50• FY11/SY10 – 18 SA waivers; $179,410,946*• FY11/SY10 – 19 MH waivers; $517,894,884*

*FY11/SY10 waiver information reflects information available as of June 7, 2011

State Funds• MH – $ 2.2 billion reduced• SA – Being Determined

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BUDGET: FEDERAL DOMESTIC SPENDING

FY 2011 Reductions• $42 Billion• SAMHSA – $38.5 mil (plus >$15 mil in earmarks)

FY 2012 Proposals• $4 – 6.5 Trillion over 10 years• Fundamental changes to Medicaid, Medicare &

federal/state roles in health care

FY 2013 Budget Development Now

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BUDGET: SAMHSAD

olla

rs in

Mill

ion

s ACA PHS BA

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BUDGET: FY 2011 to FY 2014

Focusing on the Strategic Initiatives• FY 2011 budget reductions & RFAs• FY 2012 budget proposal; SIs, IEI, moving to 2014• FY 2013 tough choices about programs and priorities

Revised Approach to Grant-Making • Braided funding within SAMHSA & with partners• Engaging with States, Territories & Tribes – Flexibility

• Funding for States to plan or sustain proven efforts• Encouraging work with communities

• Revised BG application

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BUDGET: FY 2011 to FY 2014 – 2

Implementing a Theory of Change• Taking proven things to scale (SPF, SOC, Trauma)• Researching/testing things where new knowledge is

needed

Efficient & Effective Use of Limited Dollars• Consolidating contracts & TA Centers• Consolidating public information & data

collection activities and functionsRegional Presence & Work with States

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SAMHSA’S THEORY OF CHANGE21

BLOCK GRANTS: FOCUS

Promotes consistent planning, application, assurance and reporting dates

Take broader approach – reach beyond those historically servedFlexibility – one every two years v two every yearPreparation for 2014BG dollars for prevention, treatment, recovery supports and

other services that supplement services covered by Medicaid, Medicare and private insurance

Form strategic partnerships for better access to good and modern behavioral health services

Improving accountability for quality & performanceDescription of tribal consultation activities

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BEGINNING IN 2014: 32 MILLION MORE AMERICANS WILL BE COVERED

4-6 mil

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CHALLENGES – STATE MHAs & SSAs

Individuals Served by SSAs

Uninsured61%

Insured39%

Individuals Served by MHAs

Insured61%

Uninsured39%

• 90-95 percent will have opportunity to be covered by Medicaid or through Insurance Exchanges

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BLOCK GRANT(S) APPLICATION

Comments ReceivedPositive DirectionClarifying RequirementsTimelinesReporting Burden Concerns

Plans due September 1 for 20 months

Phased in planning approach

Moving toward April 1, 2013 for next two-year application

Annual reporting

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NATIONAL BEHAVIORAL HEALTH QUALITY FRAMEWORK

National Behavioral Health Quality Framework – similar to National Quality Framework for Health• SAMHSA funded programs measures• Practitioner/system-based measures• Population-based measures

Webcast/Listening Session • Draft document on web www.samhsa.gov • June 15: 3:00 – 5:00 p.m. Eastern• In-person and webcast/telephone

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NATIONAL BEHAVIORAL HEALTH QUALITY FRAMEWORK (cont’d)

Use of SAMHSA tools to improve practices• Models (SPF, coalitions, SBIRT, SOCs, suicide prevention)

• Emerging science (oral fluids testing)

• Technical Assistance (TA) capacity (trauma)

• Partnerships (meaningful use; Medicaid & Medicare

quality measures)

• Services research as appropriate

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COMMUNICATIONS & MESSAGE

Internal: Communications Governance Council– Consolidation of Website/800 #s – saving money and

increasing customer use and satisfaction– Social Media– Review of publications & materials

External: Public campaigns in partnership with others – common messages, common approaches– STOP Act; What a Difference a Friend Makes

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NATIONAL DIALOGUE ON THE ROLE OF BEHAVIORAL HEALTH IN PUBLIC LIFE

Tucson, Fort Hood, Virginia Tech, Red Lake, Columbine

Violence in school board and city council meetings, in courtrooms and government buildings, on high school and college campuses, at shopping centers, in the workplace and places of worship

>60 percent of people who experience MH problems and 90 percent of people who experience SA problems perceive need for treatment but do not receive care

Suicides are almost double the number of homicidesAs many people need SA treatment as diabetes, but only 1.6% v 84%

receive care

SA and MH often misunderstood• Discrimination• Prejudice

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ASSESSING PUBLIC KNOWLEDGE AND ATTITUDES: WHAT AMERICANS BELIEVE

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WHAT AMERICANS KNOW

Americans have general knowledge of basic first aid but not how to recognize MI or SA, or how or when to get help for self or others• Most know universal sign for choking; facial expressions of

physical pain; and basic terminology to recognize blood and other physical symptoms of illness and injury

• Most know basic First Aid and CPR for physical health crisis

• Most do not know signs of suicide , addiction or mental illness or what to do

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CERTAINTIES OF CHANGE – 132

CERTAINTIES OF CHANGE – 233

SAMHSA PRINCIPLES34

www.samhsa.gov